Resident Emergency

[RUNEMASTER]

Im a nursing student.Can someone give me tips on what one would do initially in the following scenarios in the nursing home environment(doing rotation in nursing home)?

1.The resident says shes having a pain in her chest.

2.The resident complains of respiratory distress(visible)?

3.The resident is not moving but is still alive(breathing)?

4.The resident claims to have severe pain despite being medicated with narcotics.

Thank you in advance im a Nursing student ,but also a computer digital artist(amateur).

[HannasMom]

In another thread she says she is a nurse who hates nursing and can hardly wait to retire. Interesting, huh? Can't figure out what she is seeking.

[itsme]

She is probably just some bored kid. If not, she certainly does need to grow up!

[imenid37]

i love my many kitties. sometimes they are stinky. sometimes the attitude of people like rune stink. i think most of the answers given to rune were very appropriate. so rune.. what is your weird problem? huh?

[Katnip, RN]

My cat smells nice. He smells like powder all the time. Not sure why, but he sure smells better than the dog. (Who I love dearly)

[twinmom2k]

glow worm:

ok, it doesn't matter to me if these q's were asked b/c of an assignment. they seem like valid discussion material to me, and probably lots of students would like to know the answers. below are my guesses -- can you judge/correct them? thanks.

1.the resident says shes having a pain in her chest. (assess pain quality/location, give nitro if standing order, then call doc?)

number one i would get vital signs on any patient complaining of chest pain before administering anything. then i would use my nursing judgement as to what prn to give depending on the vital signs and other physical characteristics such as skin color, diaphoresis, where the pain is actually located and if it radiates etc. then if indicated i would give nito, reassess after 5 minutes per the md order and then if after 3 doses the pain persists call the md.

2.the resident complains of respiratory distress(visible)? (assess, call code, change postion/suction phlegm if airway blocked, give 2l o2 (or more?) if standing order & not copd, call doc, and be prepared to bag/transport to hospital?)

what do you mean by visible? what is the respiratory rate, rhythm, oxygen saturation, and lung sounds? why are you going to call a code and then suction, use your nursing interventions first before you resort to calling a code. not all episodes of respiratory distress require transport to a hospital.

3.the resident is not moving but is still alive(breathing)? (call code/emt, give 2l o2 if standing order (or more?), call md, and prepare to transport to hospital?)

again why are you calling a code without assessing your patient? that is what you are there for. call the residents name, if no response try tactile stimulation such as sternal rub. if no response get vital signs and use your critical thinking to try and figure out what might be going on with the resident. is there any facial drooping, are they unconscious? (not moving does not mean unconscious) do an accu check, get an oxygen saturation, put the resident back to bed. could just be orthostatic hypotention, low blood sugar, or it could be something worse. but you won't know unless you assess the patient and do nursing interventions. in reality you will have to do your own interventions while waiting for the md to call back, the family to be called, and if needed ems to be called anyway.

4.the resident claims to have severe pain despite being medicated with narcotics. (assess quality/location/nature, call md)

i agree with your response to this, but i would add to get those vital signs. this will tell you alot about whether this patient is really not being relieved appropriately of their pain or is just seeking drugs. how long ago have the narcotics been given? it takes longer in the elderly for their medicines to metabolize so it may just take longer for the med to work. plus if this is an acute episode that has just started being treated it may take up to three scheduled doses to provide adequate relief.

__________________

i assume by your responses that you are also a nursing student. (if not please forgive the assumption.) i have been an ltc nurse for 9 years so these types of responses have come with time and experience. you will learn that the hospital is there for situations that a ltc facility cannot handle. things like lab work, x rays, iv therapy, oxygen therapy etc. can be done at the ltc facility and i surely hope the staff there are fully capable of giving the same care as in the hospital.

your off to a great start.

good luck,

twinmom2k

[ktwlpn, LPN]

Originally posted by twinmom2k

You will learn that the hospital is there for situations that a LTC facility cannot handle. Things like lab work, x rays, IV therapy, oxygen therapy etc. can be done at the LTC facility and I surely hope the staff there are fully capable of giving the same care as in the hospital.

Your off to a great start.

Good luck,

twinmom2k

The LTC's in this area are not eqipped to do any of those things STAT-if a resident is in distress they are going to the ED for relief unless they and their s.o's have written instructions stating otherwise....Our mobile xray company comes from an hour away as does our lab...We do not inititate IV therapy and only accept patients with mid,PICC or some type of central line for antibx therapy.We also do not have a resus policy-we do NOT run codes and are not equipped to do so.Pts and their so's are told this prior to admission-our focus is on quality of life-not quantity..But DNR does not mean do not treat....I can admin O2 and nitro-also po lasix-anything else-outya go.....

[SmilingBluEyes]

I think this reeks of trolldom and I would not go out of my way to help anyone using this approach. Perhaps in ignoring this person, he/she will learn that you draw more flies with honey than vinegar and maybe use a bit of manners when talking on a forum like this. ESPECIALLY WHEN HE/SHE HAS THEIR HAND OUT! It may be bitten off this way.

[ShortFuse_LPN, LPN]

Originally posted by kids-r-fun

Thanks everyone.

I didn't want to sound mean, I thought I was very nice, actually, I had the posters best interest at heart. I have seen a few students get seriously flamed here for trying to get the answers for to homework assignments (and not doing the reading or thinking).

My observation is that students who come in and say "here is the question, here is my answer, am I on the right track?" or "here is the question, I have done this & this, but I still don't get it" are much better received...we are a great bunch of nurses and we do like students but we are not the homework help line. I was trying to guide the poster in that direction.

No need to defend yourself. Your post was in no way out of line, in my opinion.